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Results: Of 3385 participants, 235 died during follow-up and 263 were unclassified at the follow-up. Thus, after 4 years, the glucose status was available in 2887 participants (1721 or 60% women; median age=48 yrs, IQR=30-57 yrs, range=14-93 yrs; 37% with IFG at baseline, 36% hypertensive, 47% obese, 63% with central fat distribution). At follow-up, 20% with baseline IFG had DM vs 4% of participants with NFG (p<0.0001). After adjusting for age, sex, field center and kinship coefficient (to rule out possible relatedness effects), incident DM was more frequent in participants with LVH (p<0.0001) and higher UACr (p<0.04). Association with UACr became insignificant and that with LVH was attenuated (OR from 1.89 to 1.68, p<0.002) when controlling for hypertension (p<0.06) and initial glucose status (p<0.0001). Association of incident DM with LVH disappeared (OR=1.18) when controlling for obesity (p<0.003) and initial log of insulin levels (p<0.0001), with borderline significance of the amount of body fat (p=0.07). Central fat distribution was not associated with incident diabetes independently of the amount of body fat.

Conclusions: TOD conventionally attributed to diabetes precedes its clinical appearance. This association substantially depends on obesity-related abnormalities. Substantial part of the TOD attributable to diabetes is due to metabolic alterations related to the preceding obesity and insulin resistance.